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(General reference on nasal bioavailability and molecular weight thresholds.) Merkus FW, Verhoef JC, Schipper NG, Marttin E

Kidney function: No clinically significant effect

Modern Rheumatol (2013) 23(5):85663

Some of the main symptoms of vitamin B12 deficiency are Fatigue and mental weakness Weight loss, depleted energy, low appetite Breathlessness Anemia Cognitive decline, memory loss Insomnia Disorientation, depression, and confusion Hair fall, hair thinning, premature graying Mouth ulcers Constipation Irritability, mood swings Prevention and treatment of vitamin B12 deficiency Preventing and treating vitamin B12 deficiency typically involves dietary changes, supplements, or injections Dietary Sources: Increasing intake of vitamin B12-rich foods like meat, fish, dairy, and fortified foods

This is also the case for those with exocrine pancreatic insufficiency (EPI)